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The aim of this study is to evaluate if surgical experience could influence the outcomes of retrograde intrarenal surgery (RIRS) in terms of stone clearance and complication rate. Patients from five institutions were included in this study. Patients were divided into two groups. Group 1: patients treated by three surgeons in the early phase of learning curve (surgical experience100 procedures); Group 2: cases operated by two surgeons with great endourological experience (400 procedures). Patients and stone characteristics, outcome and complications were analyzed. Multivariable regression model was used. Differences between groups were estimated using propensity scores to adjust for the bias inherent to the different characteristics. 381 RIRS were analyzed (Group 1: 150 RIRS; Group 2: 231 RIRS). Clinical data and stone parameters were comparable. The SFR was 70 % in Group 1 and 77.9 % in Group 2 (p = 0.082). Operative time was significantly shorter in the Group 2 (76.3 vs. 53.1 min, p = 0.001). The overall complication rate was significantly lower in Group 2 (20.7 vs. 8.7, p = 0.001). At unadjusted analysis, a non-significant difference was found between centers on SFR (OR 1.51 95 % CI 0.95-2.41). Conversely, a significant difference was found on overall complications (OR 0.36 95 %CI 0.20-0.67) with lower overall complication in Group 2. This study shows that surgeon experience influences the outcomes of RIRS mainly in terms of safety. Further studies will be needed to assess the exact number of procedures necessary to obtain a plateau in the rate of complications and success.

Objective Plasmodium ovale malaria occurs mainly from mild form of malaria. We present a rare case of a splenic rupture secondary to complication of Plasmodium ovale malaria. Clinical presentation A 41-year-old female from Mali admitted to intensive care unit with hemorrhagic shock secondary to splenic rupture. A laparoscopic exploration was performed and patient received a massive blood transfusion for a hemodynamic stabilization. The diagnosis of malaria was confirmed by a blood smear test indicating the presence of P. ovale. A treatment of injectable Quinine was initiated with a positive outcome. Conclusion Although usually considered as a cause of a mild form of malaria, P. ovale may be responsible for a ruptured spleen which can lead to a state of life- threatening hemorrhagic shock.

The aim of this study was to compare the safety and efficacy of RIRS in men ≥65 years to those65 years.Patients who underwent RIRS were prospectively collected from March 2013 to March 2014 in 5 European centers. Perioperative outcomes and complications in elderly men were compared with men65 years. Univariable and multivariable analyses were performed for factors predicting overall complications. The groups were compared using Mann-Whitney U test. Categorical variables were compared using chi-squared test and the Yates correction or the Fisher's exact test.A total of 399 patients with renal stones were included, 308 (77.19%) were aged65 years, 91 (22.8%) were aged ≥65 years. Elderly patients were more likely to have higher ASA scores (35.7% vs 92.3%; p 001), Charlson Comorbidity Index (1.8 vs. 5.2, p 0.001), hyperlipidemia (10.06% vs. 30.76%; p = 0,0005) and coronary heart disease (5.51% vs. 17.58; p = 0.005) compared to younger cohort. Perioperative outcomes (stone free rate, operative time and re-intervention rate) did not show differences between the two groups (p 0.05). Surgical and medical complication rates were similar between the cohorts (14.28% vs 9.89%; p = 0.38). Multivariate analysis did not identify any predictive factors of complications among the two groups (p 0.05).In this study, elderly RIRS patients had comparable short term efficacy and perioperative complications to younger patients, despite a higher prevalence of comorbidity. Age itself should not be considered as a risk factor for the development of complications in patients undergoing RIRS for renal stone.

La pneumopathie est frequente chez le sujet âge. Du fait de sa semiologie souvent trompeuse avec notamment l’absence de signes specifiques, la radiographie de thorax doit etre pratiquee de facon assez large chez une personne âgee. La tachypnee doit etre recherchee systematiquement. Les scores pronostiques aident a la decision de prise en charge ambulatoire ou hospitaliere mais ne tiennent pas compte du contexte social. Le pneumocoque reste la cause la plus frequente de pneumonie du sujet âge, mais l’antibiotherapie initiale probabiliste doit aussi etre active sur les bacilles a Gram negatif et les staphylocoques.

There are no established guidelines for the treatment of disseminated strongyloidiasis in immunosuppressed patients, and many different treatment regimens have been used. Here, the case of a 48-year-old, HIV-positive, Congolese man, who was hospitalized for disseminated tuberculosis but developed life-threatening disseminated strongyloidiasis, is described. This patient died, with relapsing disseminated strongyloidiasis, 3 months after being treated with ivermectin. The reasons for this poor outcome and the various treatment options for strongyloidiasis in HIV-infected patients are discussed.

Retrograde intrarenal surgery (RIRS) is considered a safe procedure; however, infective complications are potentially serious postoperative complications. The aim of this multicentre study was to evaluate prospectively the prevalence of infective complications after RIRS and identify risk factors.Baseline data were collected, and patients were questioned regarding postoperative infective complications following RIRS. The Fisher exact test, Student t test, Mann-Whitney U test, and multivariate regression analysis were used for data analysis.A total of 403 patients from five European centers were included. Antibiotic prophylaxis was administered prior to RIRS in 100 %. Infection complications were recorded in 31 patients (7.7 %), consisting of fever in 18 (4.4 %), SIRS in 7 (1.7), and sepsis in 3 (0.7 %). Three required hospitalization for non-obstructive pyelonephritis (0.7 %). Univariate analysis revealed that coronary heart disease, chronic kidney disease, alteration of lipid metabolism, anticoagulant therapy, past surgery for renal stone, presence of residual fragments were predictors of infective complications. Multivariate analysis did not identify any patient subgroups at a significantly higher risk of infection. The low rate of complications may have limited the conclusions from our study.Using a standardized method for the definition and classification of infective complication from a multicentre prospective large database, we find a prevalence of 7.7 % of infective complication among patients undergoing RIRS for renal stone. However, to predict which patients will develop infective complications still remains a clinical challenge.

Resume La ventilation est une activite cyclique continue durant laquelle se succedent des phases inspiratoires et des phases expiratoires. Cette activite n'est pas monotone et la diversite, ou variabilite, des cycles respiratoires n'est probablement pas fortuite. Une maniere d'apprehender la complexite du controle de la ventilation pourrait etre d'etudier la variabilite dans le temps des grandeurs de sortie du « generateur ». Outre l'approche physiopathologique, un certain nombre d'etudes preliminaires montrent l'interet d'analyser la variabilite de la ventilation dans certaines conditions pathologiques. Ainsi, en reanimation la baisse de la variabilite de la ventilation pourrait etre un marqueur predictif de l'echec de l'extubation. Enfin, l'utilisation d'une assistance ventilatoire variable semble pouvoir ameliorer l'oxygenation des malades presentant une hypoxemie postoperatoire.

Objective: Pulse oximetry (SpO2) is a standard monitoring device in intensive care units (ICUs), currently used to guide therapeutic interventions. Few studies have evaluated the accuracy of SpO2 in critically ill patients. Our objective was to compare pulse oximetry with arterial oxygen saturation (SaO2) in such patients, and to examine the effect of several factors on this relationship. Design: Observational prospective study. Setting: A 26-bed medical ICU in a university hospital. Patients: One hundred two consecutive patients admitted to the ICU in whom one or serial arterial blood gas analyses (ABGs) were performed and a reliable pulse oximeter signal was present. Interventions: For each ABG, we collected SaO2, SpO2, the type of pulse oximeter, the mode of ventilation and requirement for vasoactive drugs. Measurements and results: Three hundred twenty-three data points were collected. The mean difference between SpO2 and SaO2 was –0.02% and standard deviation of the differences was 2.1%. From one sample to another, the fluctuations in SpO2 to arterial saturation difference indicated that SaO2 could not be reliably predicted from SpO2 after a single ABG. Subgroup analysis showed that the accuracy of SpO2 appeared to be influenced by the type of oximeter, the presence of hypoxemia and the requirement for vasoactive drugs. Finally, high SpO2 thresholds were necessary to detect significant hypoxemia with good sensitivity. Conclusion: Large SpO2 to SaO2 differences may occur in critically ill patients with poor reproducibility of SpO2. A SpO2 above 94% appears necessary to ensure a SaO2 of 90%.

The subpopulation of myenteric neurons able to synthesize nitric oxide was studied quantitatively in the adult rat, using the NADPH-diaphorase histochemical method on whole-mount preparations of distended distal ileum. The spatial density of NADPH-diaphorase-positive myenteric neurons was 2388 +/- 193/cm2 (S.D.; five rats), comprising about 27% of the nerve cell bodies per ganglion. Most neurons were intensely stained and displayed predominantly a Dogiel type I morphology; about 8% of the labelled nerve cells were ovoid neurons, exhibiting a pale cytoplasmic reaction product. The mean somatic size of all NADPH-diaphorase-positive myenteric neurons was 446 +/- 40 microns2, with a mean nuclear size of 96 +/- 18 microns2 (mean values +/- S.D.; five rats). Such values fell exactly within the range of neuronal sizes of the total myenteric population, marked by means of NADH-diaphorase histochemistry. Therefore, the morphometric analysis did not identify any peculiar cell size feature, characterizing this specific nerve cell subpopulation. Thus, the present study provides quantitative data on the size, density and proportion of those myenteric neurons that may synthesize nitric oxide in the distal ileum of the rat.

The application of a 2 mM solution of the cationic surfactant benzalkonium chloride (BAC) to an ileal segment produced a selective and extensive myenteric denervation. The aim of the present study was to investigate whether such a selective unbalance of the enteric nervous system in the adult rat elicited any plastic response within the mesenteric nervous structures contacting it. Acetylcholinesterase (AChE) staining, β-nicotinamide adenine dinucleotide (NADH) and β-nicotinamide adenine dinucleotidephosphate (NADPH) diaphorase histochemistry and glyoxilic acid-induced fluorescence were performed on whole-mount preparations of myenteric plexus and mesenteric nerves. In both control and BAC-treated animals nervous elements were detected along the mesenteric nerves. Although rather similar in position, shape and size, these neurons displayed striking differences with regard to their arrangement and density per nerve. In the controls, few small aggregates of neurons could be detected; more commonly, isolated nerve cell bodies were scattered along the nerve trunks. In the BAC-treated animals, numerous spherical or spindle-shaped clusters of neurons were located along the nerves; the mean neuronal density per nerve displayed a two-five-fold increase over the control values. The observed changes within the mesenteric nerves might be involved in an attempt at reinnervation of the BAC-treated intestinal segments from extraenteric sources.